Annals of Family Medicine最新文献

{"title":"Primary Care Practice Characteristics Associated With Medical Assistant Staffing Ratios.","authors":"Hector P Rodriguez, Alena D Berube, Dorothy Y Hung, Stephen M Shortell, Elliott S Fisher","doi":"10.1370/afm.3100","DOIUrl":"10.1370/afm.3100","url":null,"abstract":"<p><p>This study characterized adult primary care medical assistant (MA) staffing. National Survey of Healthcare Organizations and Systems (n = 1,252) data were analyzed to examine primary care practice characteristics associated with MA per primary care clinician (PCC) staffing ratios. In 2021, few practices (11.4%) had ratios of 2 or more MAs per PCCs. Compared with system-owned practices, independent (odds ratio [OR] = 1.76, <i>P</i> <0.05) and medical group-owned (OR = 2.09, <i>P</i> <0.05) practices were more likely to have ratios of 2 or more MAs per PCCs, as were practices with organizational cultures oriented to innovation (<i>P</i> <0.05). Most primary care practices do not have adequate MA staffing.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"233-236"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Team-Based Management of High-Priority In-Basket Messages.","authors":"Gregory Shumer, Anup Bhandiwad, John Holkeboer, Lauren Marshall","doi":"10.1370/afm.3094","DOIUrl":"10.1370/afm.3094","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"260"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thank You and Welcome.","authors":"","doi":"10.1370/afm.3115","DOIUrl":"10.1370/afm.3115","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"186"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer Screening During the COVID-19 Pandemic in the United States: Results From Real-World Health Records Data.","authors":"Andrew Chung, Qiushi Chen, William Curry, Todd Felix, Wen-Jan Tuan","doi":"10.1370/afm.3098","DOIUrl":"10.1370/afm.3098","url":null,"abstract":"<p><strong>Purpose: </strong>The COVID-19 pandemic abruptly interrupted breast cancer screening, an essential preventive service in primary care. We aimed to evaluate the pandemic's impact on overall and follow-up breast cancer screening using real-world health records data.</p><p><strong>Methods: </strong>We retrospectively analyzed a cohort of women eligible for breast cancer screening through the study period from January 1, 2017 to February 28, 2022 using TriNetX Research Network data. We examined the temporal trend of monthly screening volume throughout the study period and compared the rate of adherence to follow-up screening within 24 months after the previous screening when the follow-up screening was due in the pre-COVID period vs the COVID period. To account for multiple screenings in the longitudinal data, we applied a logistic regression model using generalized estimating equations with adjustment for individual-level covariates.</p><p><strong>Results: </strong>Among 1,186,669 screening-eligible women, the monthly screening volume temporarily decreased by 80.6% from February to April 2020 and then rebounded to close to pre-COVID levels by June 2020. Yet, the follow-up screening rate decreased from 78.9% (95% CI, 78.8%-79.0%) in the pre-COVID period to 77.7% (95% CI, 77.6%-77.8%) in the COVID period. Multivariate regression analysis also showed a lower adherence to follow-up screening during the COVID period (odds ratio = 0.86; 0.86-0.87) and a greater pandemic impact among women aged 65 years and older and women of non-Hispanic \"other\" race (Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander).</p><p><strong>Conclusions: </strong>The COVID-19 pandemic had a transient negative effect on breast cancer screening overall and a prolonged negative effect on follow-up screening. It also exacerbated gaps in adherence to follow-up screening, especially among certain vulnerable groups, requiring innovative strategies to address potential health disparities in primary care.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"208-214"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Another Record Match Day for Family Medicine.","authors":"David Mitchell","doi":"10.1370/afm.3121","DOIUrl":"10.1370/afm.3121","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"264"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forging the Future of Family Medicine at the 2024 ADFM Annual Conference.","authors":"JoBeth Hamon","doi":"10.1370/afm.3122","DOIUrl":"https://doi.org/10.1370/afm.3122","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"265-266"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quick Consult: Connecting Members to Academic Family Medicine Expertise.","authors":"Caroline Tanner","doi":"10.1370/afm.3125","DOIUrl":"10.1370/afm.3125","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"264"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1370/afm.3114","DOIUrl":"10.1370/afm.3114","url":null,"abstract":"","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"194"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Power Dynamics Perpetuate DEI Inaction: A Qualitative Study of Community Health Clinic Teams.","authors":"Laura Marie Ramzy, Samantha Pelican Monson, Helen Weng-Ian Chao, Bethany Hileman, Laura Jean Podewils, Rocio I Pereira","doi":"10.1370/afm.3099","DOIUrl":"10.1370/afm.3099","url":null,"abstract":"<p><strong>Purpose: </strong>Despite increased clinician awareness of systemic racism, lack of substantial action toward antiracism exists within health care. Clinical staff perspectives, particularly those of racial-ethnic minorities/persons of color (POC) who disproportionately occupy support staff roles with less power on the team, can yield insights into barriers to progress and can inform future efforts to advance diversity, equity, and inclusion (DEI, also referred to as EDI) within health care settings. This qualitative study explored the perspectives of staff members on race and role power dynamics within community health clinic teams.</p><p><strong>Methods: </strong>We conducted semistructured 45-minute interviews with staff members working in community health clinics in a large urban health care system from May to July 2021. We implemented purposeful recruitment to oversample POC and support staff and to achieve equal representation from the 13 community health clinics in the system. Interviews were audio recorded, transcribed, and analyzed over 6 months using a critical-ideological paradigm. Themes reflecting experiences related to race and role power dynamics were identified.</p><p><strong>Results: </strong>Our cohort had 60 participants: 42 (70%) were support staff (medical assistants, front desk clerks, care navigators, nurses) and 18 (30%) were clinicians and clinic leaders. The large majority of participants were aged 26 to 40 years (60%), were female (83%), and were POC (68%). Five themes emerged: (1) POC face hidden challenges, (2) racial discrimination persists, (3) power dynamics perpetuate inaction, (4) interpersonal actions foster safety and equity, and (5) system-level change is needed for cultural shift.</p><p><strong>Conclusions: </strong>Understanding the race and role power dynamics within care teams, including experiences of staff members with less power, is critical to advancing DEI in health care.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"203-207"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Examination Table Paper Use Mitigate the Risk of Disease Transmission in a Family Medicine Clinic?","authors":"Nathan Chiarlitti, Zachary Graves, Curtis Lavoie, Ryan E R Reid","doi":"10.1370/afm.3092","DOIUrl":"10.1370/afm.3092","url":null,"abstract":"<p><p>Reducing examination table paper (ETP) use may help curb carbon emissions from health care. Six participants applied Glo Germ (DMA International) to their hands before a common physical examination (abdominal, cardiorespiratory, hip and knee) both with and without ETP. After each exam, UV light was shined on the exam table and photographs were taken. The number of hand touches on ETP-covered areas and uncovered areas were tallied and compared using <i>t</i> tests. Despite covering more surface area, participants touched areas without ETP significantly more than ETP-covered areas (<i>P</i> <.05). Despite its continued use, patients do not have much hand contact with ETP during common clinical examinations.</p>","PeriodicalId":50973,"journal":{"name":"Annals of Family Medicine","volume":"22 3","pages":"230-232"},"PeriodicalIF":4.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11237226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}